Surgical Pathology for the Oncology Patient in the Age of Standardization: Of Margins, Micrometastasis, and Molecular Markers

From initial diagnosis through definitive treatment, pathologic evaluation plays a central role in the care of patients with cancer. All patient management is dependent on the correct tissue diagnosis. For surgically resected malignancies, the pathologic stage is widely recognized as the most accurate predictor of survival, and it typically determines the appropriateness of adjuvant treatment as well. Numerous additional pathologic factors have been shown by multivariate analyses to have prognostic significance that is independent of stage, and these may help to further substratify tumors, individualize treatment, and more accurately predict outcome. On a larger scale, pathologic data are essential for epidemiologic and clinical research and is the common language of cancer worldwide. Despite its overriding importance, however, current pathologic analysis is fraught with variations in methodology, interpretation of findings, terminology, reporting norms, and statistical approaches that compromise its utility, both to the individual patient and to the progress of cancer medicine and research. In the last 5 years, increasing attention has been focused on the negative impact of variation in pathology practices on patient care and medical progress at all levels including institutional, regional, national, and international. This problem is within the immediate ability of the pathology profession to correct, and the author's prediction for oncologic pathology over the next 5 years is that standardization based on best practices will become, itself, the standard.